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Shoppers of feminine intercourse staff ought to be focused for HIV prevention and therapy in South Africa

The unmet need for HIV prevention and treatment of sex workers, and especially their male clients, could be a major contributor to persistent HIV transmission in South Africa, according to a new study by researchers from the University of Bristol, UK.

Researchers used mathematical models to examine the contribution of commercial sex, sex between men and other heterosexual partnerships to HIV transmission in South Africa.

They found that over a ten-year period (2010-19), the sex between sex workers and their paying clients accounted for 6.9 percent of new HIV infections, while the sex between clients with their non-paying partners accounted for 41.9 percent. Sex between men contributed 5.3 percent and sex between men who have sex with men and their partners contributed 3.7 percent.

The study, published in the Journal of the International AIDS Society, also examined the potential impact and effectiveness of increasing HIV treatment in each risk group. More treatment for sex workers, their paying clients, and men who have sex with men would be up to five times more effective in reducing HIV transmission than more treatment in the general population.

Dr. Jack Stone of Bristol Medical School and lead study author said: “South Africa has made significant investments in expanding HIV prevention and treatment and is close to meeting UNAIDS HIV treatment goals. HIV infections remain more than double high as the UNAIDS 2020 target. To fill this gap and get the momentum going again, the HIV response needs to adjust to focus on those communities where the risks and disease burden are greatest, those for South Africa the female paying customers are workers. “

Professor Peter Vickerman of the NIHR Research Unit on Health in Behavioral Research and Evaluation at the University of Bristol, who oversaw the study, said: “The HIV response in South Africa has traditionally been centered on the general population. This is based on the assumption that key populations like female sex workers and men who have sex with men play a minor role in HIV transmission in countries where HIV is endemic, our results show that this is not the case and suggest that South Africa and indeed other countries may not do so. New initiatives focus on those who need them most, who in South Africa are the paying customers of sex workers. ”

Dr. Jenny Coetzee, CEO of the African Potential Foundation and Principal Researcher of the Perinatal HIV Research Unit, who contributed data from a study of male clients, said: “The HIV response in South Africa is responsible for prevention and behavior. It is important that we start To involve men in the solution. This study underscores the importance of a criminalized and often marginalized group of men who have clearly been overlooked in our national response. “

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Paper:

Estimation of the contribution of key populations to HIV transmission in South Africa. Jack Stone et al. Journal of the International AIDS Society. February 2, 2021.

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